Liver and Intestine Transplantation in the United States 1998-2007
Liver and Intestine Transplantation in the United States 1998-2007
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DOI：
10.1111/j.1600-6143.2009.02567.x
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发表时间：
2009-01-01
影响因子：
8.8
通讯作者：
Mazariegos, G. V.
中科院分区：
文献类型：
--
作者：
Berg, C. L.;Steffick, D. E.;Mazariegos, G. V.
从2004年到2007年，美国的肝移植数量保持不变，而等待名单上的候选人数量呈下降趋势。2007年，候选人名单是1999年以来最少的，大多数候选人为50岁以上的成年人。非胆汁淤积性肝硬化最常见。大多数年龄组的等候名单死亡率有所下降;然而，1岁以下儿童的死亡率最高。2007年，心脏性死亡（DCD）供体的肝移植使用增加。终末期肝病模型（MELD）/终末期肝病儿科模型（PELD）评分自2002年以来变化很小，MELD/PELD < 15占等候名单的75%。同期，MELD/PELD < 15的移植数量从16.4%下降到9.8%。肝细胞癌例外情况略有增加。从2006年开始，肠移植等待名单有所减少，大多数候选人是5岁以下的儿童。死亡率有所改善，但仍然高得令人无法接受。已经实施了政策变化，以改善肠移植物的分配和回收，从而对死亡率产生积极影响。除了评估肝和肠移植的趋势外，我们还深入审查了与器官接受率、DCD、活体供体移植和MELD/PELD例外相关的问题。
Liver transplantation numbers in the United States remained constant from 2004 to 2007, while the number of waiting list candidates has trended down. In 2007, the waiting list was at its smallest since 1999, with adults >= 50 years representing the majority of candidates. Noncholestatic cirrhosis was most commonly diagnosed. Most age groups had decreased waiting list death rates; however, children < 1 year had the highest death rate. Use of liver allografts from donation after cardiac death (DCD) donors increased in 2007. Model for end-stage liver disease (MELD)/pediatric model for end-stage liver disease (PELD) scores have changed very little since 2002, with MELD/PELD < 15 accounting for 75% of the waiting list. Over the same period, the number of transplants for MELD/PELD < 15 decreased from 16.4% to 9.8%. Hepatocellular carcinoma exceptions increased slightly. The intestine transplantation waiting list decreased from 2006, with the majority of candidates being children < 5 years old. Death rates improved, but remain unacceptably high. Policy changes have been implemented to improve allocation and recovery of intestine grafts to positively impact mortality. In addition to evaluating trends in liver and intestine transplantation, we review in depth, issues related to organ acceptance rates, DCD, living donor transplantation and MELD/PELD exceptions.